Tutorial Two

Question 1

gingival abscess

Answer 1

localised purulent infection involving marginal gingiva or interdental papilla

Question 2

clinical features of a gingival abscess

Answer 2

rapidly expanding localised area of swelling that may be shiny and smooth or pointed
suppuration may be present
tend to occur in previously healthy gingiva and are due to impacted foreign objects e.g bit of nail

Question 3

symptoms of a gingival abscess

Answer 3

painful
tender to palpation

Question 4

treatment of gingival abscess

Answer 4

should be incised, drained and irrigated with saline
mechanical debridement may help remove aetiology
short term salty or CHX mouthwash may be of use if area painful

Question 5

periodontal abscess

Answer 5

localised accumulation of pus within gingival wall of periodontal pocket resulting in destruction of collagen fibre attachment and the loss of nearby alveolar bone

Question 6

clinical appearance of a periodontal abscess

Answer 6

ovoid swelling on gingiva along lateral border of root
usually associated with a deep periodontal pocket, will see bleeding and tenderness on probing
suppuration may occur through sinus or through pocket opening

Question 7

sensibility testing response to tooth with periodontal abscess

Answer 7

positive

Question 8

treatment of periodontal abscess

Answer 8

if hopeless prognosis - extraction
incision, drainage and thorough debridement of pocket

Question 9

pericoronitis vs peri-coronal abscess

Answer 9

pericoronitis: inflammation of soft tissues surrounding the crown of a partially erupted tooth
peri-coronal abscess: localised accumulation of pus within the overlying gingival flap surrounding the crown of a tooth

Question 10

symptoms and appearance of pericorontitis/ peri-coronal abscesses

Answer 10

red, swollen gingivae surrounding partially erupted tooth, possibly suppurative , tender to touch
swelling of cheek at angle, trismus and pain radiating to ear is common

Question 11

treatment of pericoronitis/peri-coronal abscess

Answer 11

assess whether operculum recieving trauma from opposing tooth
irrigation and debridement
possible extraction in future

Question 12

perio-endo lesion

Answer 12

localised area of infection arising as a result of communication between the pulp and periodontal pocket

Question 13

clinical features of a perio-endo lesion

Answer 13

abscess will be associated with a non - vital tooth
smooth, shiny swelling of gingiva, TTP
may be purulent exudate or sinus tract
negative response to sensibility tests

Question 14

how may a perio endo lesion occur

Answer 14

pulpal origin - extending into deep pocket via apex
periodontal origin - reverse of above, accessory canal giving access to pulp

Question 15

treatment of perio-endo lesion

Answer 15

endo treatment first
then thorough debridement of pocket

Question 16

classifying endo-perio lesions

Answer 16

first need to establish whether lesion is in a periodontitis or non-periodontitis patient
then graded 1-3
1 - narrow, deep perio pocket at 1 tooth surface
2 - wide deep perio pocket at 1 tooth surface
3 - deep perio pockets at >1 tooth surface

Question 17

periapical vs periodontal abscess

Answer 17

periapical - pulpal origin (deep restorations, caries, toothwear), negative sensibility tests
periodontal - periodontal origin (periodontitis, deep pockets) , positive sensibility tests

Question 18

characteristic shape of an endo-perio lesion on a radiograph

Answer 18

J shape
goes to apex of one root